Is telehealth a no-brainer in Australia?

Jackie Plunkett Director of the Australasian Telehealth Society started by saying, ‘Telehealth should be one of the no-brainers in healthcare.’ When properly adopted Plunkett argued that ‘it’s the bridge to our patients. We will be able to attend to them based on need, not on location.’

However the journey from ‘should’ to ‘is’ is not going to be an easy one, with many hurdles that are preventing it from having the impact it should.

One of the key problems raised was interoperability. Jackie likened technology in telehealthcare ‘to sex in a marriage’ she observed to much laughter, ‘If the marriage is working then sex is 10% of the benefit, but if it’s not it’s 90% of the problem.’

What are clinicians’ experiences with telehealth?

The panelists expanded on some of the issues they have witnessed in their daily roles.

Dr Nathan Pinskier argued that for telehealth to make a true impact there needed to be a strategy in place, to create a practice that assessed all the technologies coming out, the different standards of those technologies and to assess various corporate interests.

He also spoke on a practical level of the difficulties GPs and clinicians are facing in using the technology. He said, ‘In a practice, there are very few reasons why you may need telehealth technology in a metropolitan practice, and fitting the education, the software setup and the consultations themselves into an already heavy workflow isn’t appealing. Add to that the process itself can be challenging and frustration, then there isn’t really any impetus for them to adopt the technology.’

Prof. David Hunter, Professor of Medicine, University of Sydney & Royal North Shore Hospital, said that his experiences in using telehealth with ageing patients also uncovered challenges with the friendliness of the resource. He observed, ‘I work with an ageing population. We have to build resources that are favourable for use for those patients and that solution needs to be scaled, needs to be field tested. But there is an appetite for these technologies. I know that some of my patients would prefer to get advice on weight-loss and exercise through SMS or Skype in the comfort of their own homes, rather than spend three hours in a waiting room.’

However others have had very positive experiences with these technologies. Professor Yogi Kanagasingam, Professor, School of Medicine, University of Notre Dame found that by being able to treat patients in very remote areas of Queensland and Western Australia had a very positive impact on those communities. He noted, ‘These patients can get relevant advice from ophthalmology experts quickly and easily. The doctors have found the technology relatively easy to use and it’s made a big impact in those communities.’

In her work in psychology Professor Jeannette Milgrom, Director, Department of Clinical and Health Psychology has also had some really positive experiences. ‘We found that when patients found this service, they find that they really like it, but it’s getting them to be aware of the technology. Before they use the service, they need to feel comfortable that it’s going to deliver the goods. But I think that when it does engage someone, they stay in. It’s the initial part of getting to those people.’

Face-to-face

Another issue the panelists found was that both patients and clinicians largely preferred seeing one another face-to-face. Dr Pinskier noted, ‘Nothing beats a face-to-face consultation.’ Prof. Hunter agreed with that, especially when talking about changing behaviours of patients suffering from chronic illnesses. He noted ‘the biggest factor for change is behaviour. And nothing beats the whites of the eyes, for those conversations.’

However Dr Pinskier noted that it’s not always possible to have these conversations face-to-face, ‘ There are many circumstances, particularly remote and rural where that’s not feasible.’ To that end Prof Milgrom described how her department have introduced a ‘coaching component to better the quality of these interactions. ‘It’s incredibly important with remote health that you can design these strategies that you can implement remotely.’

The future of telehealth

The overarching consensus was that if telehealth was to be a dynamic force in the healthcare community then there needs to be more advocacy and adoption. Prof. Kanagasingam said, ‘We need someone who can be a champion for telehealth technology in this country, Human acceptance is also a key factor.’

For that the panelists said there needs to be more training of clinic staff, more streamlined standards and a better funding model. If we could navigate our way through these issues, then telehealth could be an important tool in providing excellent care to Australians.